Centered on learning, but is it learner centered?: Paediatric resident perspectives on competency-based medical education.

backgroundLike other Canadian specialty postgraduate training programmes, paediatrics recently transitioned to a competency-based medical education (CBME) platform. This programme, the Royal College of Physicians and Surgeons of Canada's Competence By Design (CBD), is espoused as learner-centered. However, resident voices were underrepresented in CBD's creation, and there are emerging concerns that its practical implementation may have unintended effects on this population. We sought to understand how CBD has affected the educational experiences of paediatric residents, with the goal of leveraging their insights to further strengthen this training model.

methodsOur qualitative instrumental single case study explored the perspectives of paediatric residents who began training in the inaugural CBD cohort in 2021. We conducted semi-structured interviews with fourteen residents during their third year (August 2023-February 2024) in two Canadian programmes. We constructed themes from this data set using reflexive, inductive thematic analysis, looking for regularities that transcended the particularities of the training context.

resultsOur results suggest that residents agree with CBD's espoused purpose, yet feel that its day-to-day implementation has impacted them in four key ways: 1) the onus of responsibility and administrative burden falls to residents; 2) entrustable professional activities generate variable feedback; 3) CBD is less assessment for learning more assessment of learning; and 4) staff physicians have struggled to embrace CBD. DISCUSSION: Our findings align with concerns raised in other specialties, opening up questions as to why a learner-centered system may be having deleterious effects on its residents. We suggest that if the field is to fully unlock the potential that CBME systems hold, it is necessary to engage productively with resident critiques and to more deeply consider the effects that its historical and ideological aspects-such as its desire to materially demonstrate the acquisition of learner competence as well as a neoliberal orientation-have on CBME's contemporary design and delivery.